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Palmar fibromatosis (Dupuytren's contracture)

 

Palmar fibromatosis (Dupuytren’s contracture) is a condition in which connective tissue in the palm of the hand becomes tight and shortened, pulling the fingers inwards toward the palm.

The development of the condition usually occurs quite slowly over many months, or even years, though in rare cases it can develop suddenly. It can affect any of the fingers, but it most commonly affects the two fingers furthest from the thumb. It can occur in only one hand or in both hands at the same time. 

Risk factors

Palmar fibromatosis is the abnormal thickening and tightening of the normally loose and flexible palmar fascia tissue that lies beneath the skin of the palm and fingers. It is a relatively common condition but its cause is not fully understood. In most cases it does not occur until after the age of 50 years and it is more common in men than women.

Palmar fibromatosis runs in families and is more common in people of Northern European or Scandinavian ancestry. 

Other factors that may increase the risk of developing palmar fibromatosis include: 

Signs and symptoms

Often the first sign of the condition is a painless lump or nodule in the palm of the hand near the base of the fingers. This may be followed by a feeling of tightness and/or tenderness in the fingers. 

As the condition progresses it is difficult to fully straighten the fingers and there may be dimpling and puckering of the skin over the area. Eventually contracture of the fingers may become so severe that they cannot be used.

Palmar 1

 

The condition is not painful. However, some pain may be experienced if the fingers are forcibly straightened. In some cases, the muscles in the hand may become weakened and wasted through not being able to be properly used. 

As the condition progresses, palmar fibromatosis can limit the ability to perform certain tasks such as typing and grasping objects. The affected hand can get caught when trying to get into narrow places such as a pocket.

Diagnosis and treatment

A physical examination of the hand and assessment of a person’s medical and family history are normally enough for a doctor to diagnose palmar fibromatosis. 

Treatment will depend on the severity of the condition. If the condition is not severe, and is not preventing a person from doing things they need to do with their hands, treatment may be minimal.

Gentle stretching exercises and the application of heat and/or ultrasound may be recommended by a doctor or physiotherapist. If there is pain or inflammation in the area, corticosteroid injections directly into the affected area may be recommended.

Surgery

Once palmar fibromatosis progresses to a point where the condition is limiting or disabling, surgery is usually recommended.

The surgical procedure is known as a “fasciectomy” and involves making an incision in the skin of the palm above the affected area — often in a zig-zag pattern. The scar tissue is exposed and removed, allowing the fingers to flex and contract normally. This is a relatively simple and highly successful procedure. It is usually performed under a local anaesthetic or nerve block that numbs the arm.

Surgery is followed by a period of recovery and rehabilitation. The time required for this will vary between individuals. It may be necessary to wear a bandage, cast, or splint for a short time after surgery. Physiotherapy and an exercise programme will be recommended to help restore finger mobility and function.

There is a possibility that the condition can recur after it has been surgically corrected. This tends to be related to the age of onset — the earlier in life the condition develops the more likely it is to recur after surgery.

Needling

Needling (needle aponeurotomy) involves inserting a needle through the skin to puncture and break the tissue that is causing the finger to bend. Needling is done under a local anaesthetic and can be performed on several fingers at the same time.  Recovery is fast with minimal physical therapy required afterwards. However, needling is not suitable for all types of palmar fibromatosis and the condition tends to return more quickly than with surgery.

Enzyme injection

Collagenase is an enzyme that is injected into the cord of tissue responsible for the bending finger to dissolve it so that the finger can be manipulated and straightened. Recovery is quicker than with surgery. 

However, not all cases of palmar fibromatosis can be treated this way, and collagenase is not yet an established treatment in New Zealand.

References

Healthinfo clinical advisors (2017). How is Dupuytren treated? (Pamphlet PDF). Christchurch: South Canterbury District Health Board. https://www.healthinfo.org.nz/patientinfo/109180.pdf
Kovacs, E. (2020). Dupuytren contracture (Web page). Medscape Drugs and Diseases. New York, NY: WebMD LLC. https://emedicine.medscape.com/article/329414-overview [Accessed: 02/11/20]
Mayo Clinic (2020). Dupuytren’s contracture (Web Page). Rochester, MN: Mayo Foundation for Medical Education and Research. https://www.mayoclinic.org/diseases-conditions/dupuytrens-contracture/symptoms-causes/syc-20371943 [Accessed: 02/11/20]
O’Toole, M.T. (Ed.) (2017). Dupuytren’s contracture. Mosby’s Dictionary of Medicine, Nursing & Health Professions (10th ed.). St Louis, MI: Elsevier.

Last Reviewed: October 2020

 

 
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